Aortic and Peripheral Vascular Disease Flashcards Preview

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Flashcards in Aortic and Peripheral Vascular Disease Deck (30):
1

Arteriosclerosis

  • Definition
  • 3 types

  • Definition
    • Hardening & thickening of artery walls
  • 3 types
    • Atheroslcerosis
    • Mönckeberg medial sclerosis
    • Arteriolar sclerosis

2

Atherosclerosis

  • General
  • Risk factors
    • Non-modifiable
    • Major modifiable
    • Minor modifiable

  • General
    • Often used itnerchangeably w/ arteriosclerosis
    • Intimal atheromas (fibrofatty plaques)
    • Leading cause of morbidity & mortality in the Western world (~50% of all deaths)
      • Much of this mortality is realted to coronray artery disease
  • Risk factors
    • Non-modifiable
      • Age, gender, genetics
    • Major modifiable
      • Smoking, diabetes, HTN, hyperlipidemia
    • Minor modifiable
      • Obesity, lifestyle

3

Mönckeberg Medial Sclerosis

  • Calcification & often ossificaiton of the muscular media
  • Does NOT impinge on vessel lumen

4

Arteriolar Sclerosis

  • Involves arteriorles
  • 2 types
    • Hyperplastic: intimal thickening
    • Hyaline: acellular thickening

5

Pathogenesis of Atherosclerosis

  • Response-to-injury hypothesis
  • Key points
  • Fatty streak
  • Atheromatous plaque
  • Complicated plaque

  • Response-to-injury hypothesis
    • Intimal (endothelial) injury
    • Inflammation
  • Key points
    • Turbulent flow & lipids are most important in plaque development
    • Endothelial cell loss due to any type of injury results in intimal thickening
    • The role of infection isn't conclusive
  • Fatty streak
    • Earliest lesion
    • Flat
    • Can be seen outside of lipid pathology setting (infants, adolescents)
  • Atheromatous plaque
    • Raised
    • Impinges on vessel lumen
    • Eccentric (not around entire circumference)
    • Can enlarge, change shape, & calcify
  • Complicated plaque
    • Calcified
    • Ulcerated
    • More thrombosis on surface
    • Can rupture & embolize
  • Add image from Atherosclerosis flashcard

6

True or False: You have to have high cholesterol to get atheroslcerosis

False

7

Atherosclerosis Sites (In Descending Order)

  • Lower abdominal aorta
  • Coronary arteries
  • Popliteal artery
  • Internal carotid artery
  • Circle of Willis

8

Clinical Effects of Atherosclerosis

  • Arterial narrowing
  • Thrombosis
  • Embolism
  • Aneurysm

9

Thrombosis

  • Blood clot that formed at the site you found it
  • Acute change in plaque
    • Erosion, ulceration, hemorrhage, rupture
    • Small to medium sized vessels
  • Typically in the setting of a vulnerable plaque
    • Thin fibrous cap
    • Moderate luminal narrowing
    • Lipid rich center

10

Embolism

  • Blood clot that formed somewhere else & traveled to another site through vasculatur
  • Initiated by rupture or erosion of plaque
  • Most from aorta
    • To organs or lower limbs (gangrene)
  • If from carotid
    • Stroke
    • "Carotid bruit" ntoiced on exam (atheroma)

11

Arterial vs. Venous Emboli

  • Arteriol embolus
    • Leads to stroke, heart attack, gangrene
  • Venous embolus
    • Leads to pulmonray embolism

12

Aneurysms

  • Pathophysiology
  • Types
  • Common aneurysms

  • Pathophysiology
    • Weakening of the vessel wall
      • In atherosclerosis, this is due to damage to the media
    • Dilation
    • Rupture
  • Types
    • Saccular
    • Fusiform
    • Dissecting
    • (Mycotic)
    • (Syphilitic)
  • Common aneurysms
    • Abdominal aortic aneurysm (AAA)
    • Aortic dissection
    • Cerebral berry aneurysm
    • Mycotic aneurysm
    • Syphilitic aneurysm

13

Abdominal Aortic Aneurysm

  • General
  • Clinical considerations
  • Treatment

  • General
    • Due to atherosclerosis
    • True fusiform aneurysm
    • Plaques damage & weaken media
    • Abdominal aorta below renal arteries
    • Men > women, >60yo
    • Clinically significant when >5cm in diameter
  • Clinical considerations
    • "Pulsatile abdominal mass"
    • Sudden death from rupture, leads to insanguination & hemodynamic collapse
  • Treatment
    • Placement of aortic / endoluminal graft

14

Dissecting Aneurysm (Aortic Dissection)

  • 2 types
  • General
  • Classic symptoms
  • Classic chest x-ray finding

  • 2 types
    • Hypertensive / atherosclerotic
    • Genetic (Marfan Syndrome)
  • General
    • Cystic medial degeneration
    • Dissection usually starts in arch of aorta or aortic root
    • Myxomatous degeneration of the aortic wall
    • Fragments elastic fibers
    • Weakens tunica media
  • Classic symptoms
    • Sudden onset of excruciating chest pain
    • May radiate to middle of the back
  • Classic chest x-ray finding
    • Widening of the mediastinum due to mediastinal hemorrhage

15

Cerebral Berry Aneurysm

  • General
  • Rupture results in...
  • Clinical signs of rupture

  • General
    • Not atherosclerotic
    • Congenital weakening of vessel wall
    • Typically at branch points in Circle of Willis
  • Rupture results in...
    • Subarachnoid hemorrhage
    • Intraparenchymal hematoma
  • Clinical signs of rupture
    • Sudden onset of excruciating headache
    • Sudden loss of consciousness

16

Syphilitic (Luetic) Aneurysm

  • Causes
  • Results

  • Causes
    • Not atherosclerotic
    • Tertiary syphilis
    • Treponema infects vasa vasorum
    • Linear calcification of elastic lamina ("Tree barking")
  • Results
    • Dilation of arotic valve ring & ascending aorta
    • Aortic insufficiency

17

Mycotic Aneurysm

  • Not atherosclerotic
  • Not syphilic
  • Caused by infection of blood vessel
  • Bacterial or fungal
  • Typical is Salmonella gastritis

18

Which of the following aneurysm types is exclusively due to atherosclerosis?

  • Thoracic aortic dissection
  • Cerebral berry aneurysm
  • Abdominal aortic aneurysm
  • Mycotic aneurysm
  • Leutic aneurysm

Abdominal arotic aneurysm

19

Varicose Veins

  • Tortuous dilation of lower extremity veins
  • Secondary to increased venous pressure
    • Standing for long periods of time
    • Pregnancy
  • Venous vales become incompetent
  • Low risk of venous thrombosis

20

Thrombophlebitis / Phlebothrombosis

  • Difference
    • Thrombophlebitis: inflammation
    • Phlebothrombosis: no inflammation
  • Deep vein thrombosis of lower extremities
  • Other sites: pelvic veins, prostatic veins, dural sinuses
  • Hpercoagulable states can predispose
  • Major complication: pulmonary embolus

21

Superior / Inferior Vena Cava Syndrome

  • Obstruction of vena cava
  • Due to neoplasm (i.e. lung cancer, liver cancer)
  • Symptoms relate to area of obstruction

22

Scenario 1

  • 59yo man
  • Diabetes mellitus type 2
  • Now has peripheral vascular disease

Atherosclerosis (atheromatous plaques)

23

Scenario 2

  • 61yo woman
  • Essential hypertension
  • Increasing BUN & creatinine
  • Developing signs of renal insufficiency

Arteriolar sclerosis (hyperplastic or hyaline)

24

Scenario 3

  • 68yo man
  • Calcificaiton of his radial artery during an x-ray for a forearm injury
  • No vascular symptoms

Mönckeberg medial sclerosis (aka medial calcific sclerosis)

25

Scenario 4

  • 70yo woman
  • Systemic atherosclerosis
  • Carotid bruit
  • Now has symptoms of a cerebral infarct (stroke)

Embolism (form carotid atheroma)

26

Scenario 5

  • 74yo man
  • Pulsatile abdominal mass on physical exam
  • Suddenly becomes hypertensive
  • Develops hemodynamic collapse

Ruptured abdominal aortic aneurysm

27

Scenario 6

  • 68yo woman
  • Essential hypertension
  • Sudden onset of excruciating chest pain radiating to the middle of her back
  • Collapses & becomes unresponsive

Dissection of thoracic aorta

28

Scenario 7

  • 35yo man
  • Marfan's syndrome
  • Sudden onset of excruciating chest pain radiating to the middle of his back

Dissection of throacic aorta (cystic medial degeneration or necrosis)

29

Scenario 8

  • 43yo man
  • Recent recurring low-grade headaches
  • "Worst headache of his life"
  • Suddenly collapses

Rupture of cerebral berry aneurysm (recent "leakage")

30

Scenario 9

  • 69yo woman
  • Stage IV cancer of the right lung
  • Gradual swelling & edema of her right arm
  • Jugular venous distension
  • Capillayr congestion of her head & neck

Superior vena cava syndrome